MEDICARE: FOOTHILL FAMILY CLINC INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902868177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTHILL FAMILY CLINC INC.

Provider Business Mailing Address
First Line	:	6360 S 3000 E
Second Line	:	SUITE 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6923
Country	:	US
Telephone Number	:	801-365-1032
Fax Number	:	801-365-1033

Provider Business Practice Location Address
First Line	:	6360 S 3000 E
Second Line	:	SUITE 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6923
Country	:	US
Telephone Number	:	801-365-1032
Fax Number	:	801-365-1033

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. HEATHER ALCORN
Credential	:
Telephone Number	:	801-365-1032

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	08/22/2020

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